AbstractBackgroundTo evaluate the surgical outcome of patients with huge solitary hepatocellular carcinoma (HCC, ≥10 cm in diameter) without major vascular invasion.MethodsWe retrospectively studied 177 patients with huge HCC (≥10 cm in diameter) who underwent hepatectomy from 1990 to 2008. Surgical outcomes and clinicopathological characteristics were compared among 54 patients with solitary HCC without a major portal vein tumor thrombus (MPVT), 53 patients with multiple HCCs without MPVT, and 70 patients who have HCC with MPVT.ResultsThe mean tumor size and indocyanine green retention rate at 15 min showed no significant difference among patients groups. The overall 5‐year survival rate was significantly higher in patients with solitary HCC (79%) than in patients with multiple HCCs (31%, P < 0.0001) and MPVT (17%, P < 0.0001). In patients who underwent curative surgery, the 5‐year disease‐free survival rate was significantly higher in patients with solitary HCC (48%) than in patients with multiple HCCs (12%, P = 0.0008) and MPVT (12%, P = 0.0003). Multivariate analysis showed solitary HCC to be a significant independent prognostic factor for overall survival and disease‐free survival.ConclusionsPatients with solitary HCC without MPVT show a favorable surgical outcome even for tumor size ≥10 cm in diameter. J. Surg. Oncol. 2013;107:408–413. © 2012 Wiley Periodicals, Inc.